Tag: ED

Wow, it has certainly been too long since I wrote in my blog. Christmas came and went, as did new years, yet I hadn’t written a thing in my blogs.

These past few weeks have been both relaxing and busy. On my medical rotation, the consultant was busy admitting a lot of patients, so I was kept busy. Ridiculous hours ensued, with me leaving on most days around 6-7 pm. It didn’t matter; I felt I learned a bit, and the work wasn’t very stressful, so I felt ok with it.

Today felt like I was coming back from a long break. I had a total of 6 days off work, before going back into ED. And what deja vu I got. I felt like I was repeating things from 4 months ago – same environment, same senior ED doctors. Except now I was writing JHO at the end of my name. Yeap, it’s officially the first day that I’m no longer an intern anymore. I’m a fully registered doctor. But I’m scared. Scared that I still don’t know enough about medicine. Scared of the night shifts that I will be doing in about a weeks time, where there will only be me, another resident and a PHO managing all the patients from 10pm until the next morning. I don’t feel ready. I don’t feel ready at all to be managing a large patient work load.

The other deja vu feeling, was walking into the kitchen area and toilets. Reminiscing the feeling of feeling extremely lost close to 6 months ago. Lost in the work I was doing (because I had no clue what I was doing) and feeling lost personally (due to breakup with girlfriend). Walking into the toilets gave me a momentary feeling of feeling lost again, and I realized how lost I felt half a year ago. Dread would fill me up at work, and I couldn’t help but feel despair on some days, and hopelessness. The only hope I held out, was that the pain of heart break would be temporary, and the suffering of the nature of my work would soon be ending as well. They were tough times I remember.

I still don’t know how tough round 2 of ED will be, but I feel more confident in myself. Perhaps it’s the experience in the past year?

My aim for this year, would be to write more regularly in this blog (at least twice per week). It will give me relief from the stresses of work, let me speak my mind, and let me see things from a new perspective.

So I’ve been unwell this past week, with mainly flu like symptoms (sore throat, coughs, joint aches). I knew it was probably just the standard run of the mill flu symptoms, but it was only in the past few days that something bothered me; pleuritic chest pain.

Waking up from sleep, I had a sharp well localized pain on the R side of my back. Deep inspiration seemed to exacerbate this pain. That got me a little worried, because it meant I had pleuritic chest pain! And with it, it meant inflammation of the pleural lining, something I was taught in medical school, was something quite serious.

Worry setting in, I decided whether to go to the ED department for treatment or not. I mean, it would be long waiting times maybe, and it would be weird in a way to be treated by previous colleagues. After pondering, and a great deal of reluctance, I decided to go. The possibility that I could deteriorate and be much worse off was enough to get me going.

The triage nurse recognized me “you work here don’t you?”. That was the first part of awkwardness; being recognized by other staff members.

The ED waiting room was empty. The TV blaired on in the background, with news reports. I took out my smartphone, and started to study some Chinese. And from this point, you could tell that I wasn’t really that sick. I guess I wanted more reassurance, and to just get seen just in case of something serious.

I got my observations and vitals done, and was then sent into the fast track room. There, I did some more waiting, waved at a colleague, and got attended to by one of my previous colleagues. So I explained my story, throwing in medical terms like pleuritic chest pain and such. The obligatory chest exam was done, with auscultation of lungs. Then I got sent for a CXR. And then, I got an ECG.

The senior doctor came in and saw me, asking me how I was. She had a new hairstyle from when I last saw her. Essentially, I had pleurisy, with no need for antibiotics, just some rest, and NSAIDs. It was a relief I guess.

All in, it took about 2 hours and 20 minutes. The funny thing is, that right after I left the department, my pleuritic pain disappeared! How convenient. If it happened earlier, there would be no need to go to the ED, and I could have avoided the awkwardness of being seen by colleagues. But it was interesting to know what it was like as a patient, sitting in the seats, and being in the other spot as a patient, as opposed to being the doctor.

What was even more amusing, was that as I rocked up for my afternoon work, the other doctors had known I was at ED earlier that morning, and were asking me if I was ok.

Sigh…. I vow to never be sick again as to need to be seen by ED again.

Meeting up with a colleague for dinner a few nights ago, I was reminded of how smooth life can be at times. Here I was, little worries (since it was after work) and chilling at dinner with a friend.

My friend looks at me with a serious expression on her face.

“I’ve got something to tell you, but please don’t tell anyone else.”

“Yea, sure” I reply casually.

“You know X, one of our colleagues from the Emergency Department? She has resigned due to the pressure put on her by one of the consultants. She’s now got depression. I saw her at the supermarket the other day, and she looked like a lost soul”

I looked at her with a bewildered expression. I remembered that colleague. She was nice and friendly, although I had only spoken to her like 3 or 4 times. I thought back to my interactions with that particular consultant, and reeled with disgust. He often put the junior staff down, and humiliated them in front of other doctors. I hated presenting cases to him, because he would constantly interrupt my flow of thought, and point out my mistakes. He was rude and disrespectful.

I felt sad too for my colleague who was now suffering depression from such a horrible human being. I couldn’t imagine what suffering she must have put up with, the tortures of putting up with such a man.

My friend and I both sat in silence for a while.

We both hoped karma would come back and get this man for his horrible actions. I don’t know what else to do to help. I felt wronged by this man, and I’m sure several junior doctors have suffered immensely from him as well. But I don’t know what to do. The environment in ED is just toxic, and days have come and gone where I question my abilities, I question why I am still doing medicine.

Are there things we are just supposed to put up with such as these? I’m going to be dealing with this man again probably next year. If I report him early and he loses his job, I won’t have to see him again next year.

If I were to use one word to describe my ED rotation, I would use the word “hell”. In saying this, I feel that I have learned an incredible amount of things from my ED rotation, but at the cost of my self esteem, and perhaps a little bit of my sanity.

It wasn’t the stress of seeing unfamiliar patient presentations that freaked me out the most, but rather in dealing with the senior doctors and the culture of degradation of junior doctors.

As junior doctors, we were thrown in the deep end. We were doing the same job that a registrar in ED would be doing, working up the patient, performing appropriate investigations, and making referrals. It was tough work.But this tough work I could cope with. It was even challenging, and something I learned a lot from. The thing I couldn’t cope with, were the staff. Not all were terrible, but I could say that a few were quite bad, with one particular man who seemed to be hated by everyone, including surgical registrars.This man yelled at me on the second day of work. I got yelled in front of almost all the other ED doctors for asking my senior doctor to describe an open fracture he had seen earlier that day, so that I could relay it back to the orthopaedic doctor. Words to the effect of “incompetent”, and “idiot” were used. That night, I couldn’t sleep, dreading the next day and fearing how it would turn out. It wasn’t until just a few days ago, that I found out other colleagues have cried at home from this very man yelling at them.

And so, for the next few weeks, I was mentally tortured by this very man who we had to run all our cases through. He would question my competence as a doctor, carefully pointing out my mistakes, and how I had forgotten to do things such as chart regular pain medications, hence why the patient is suffering excruciating pain.

On more days then not, I sat on the edge of my bed, thinking about the mistakes I made, and questioning myself whether I was competent or not. It was self abuse, and completely self defeating. I would dread the next day that I had to get up to go to work. Finishing work was the most relieving feeling ever, but on days that I was yelled at, or pointed out numerous mistakes, even that feeling of relief was taken away, to be replaced by frustration, anger and thoughts of worthlessness at the end of my shift.

To me, I felt worthless at my job. I wasn’t getting the support I needed, I never got the encouragement or acknowledgement that I was learning from my mistakes, or doing a better job than I was doing in the past. They didn’t take the time to explain my mistakes, and how I could avoid such mistakes next time, but they pointed out my mistakes, reinforcing the message that I was doing badly. In hindsight, I wasn’t doing badly, but I was doing something in which they held unrealistic expectations of me as a junior doctor.

What doesn’t kill you only makes you stronger right? In that sense, I feel stronger having put up with such degradation, and the subjected self torture. The biggest lesson I learnt was in dealing with ***holes in medicine. Learning to deal with other people – it’s an important life skill, and it will surely help you to survive in this big bad world.

This will be my first post on this brand spanking new blog I just created. I got a fantastic website address: livingmedical. Brilliant isn’t it? I mean, everyday I’m at work, I’m living medical. Even when I’m not at work, I’m living medical, because if someone had a medical problem like a VF (ventricular fibrillation) in front of me, I have a duty of care to attend to that person.

So anyway, back to the topic of being an ED intern. ED is a scary place!!!!!! The environment is hectic, you have different triage categories, you have people who come in with any type of presentation! Anyway, as an intern in ED, I have to see patients – I take a history, do clinical exams, order appropriate investigations, and provide initial management such as pain relief, oxygen etc, and then discuss this with the senior doctor who will advise of further management as necessary. Sometimes, I may have to refer the patient to the surgical or medical team, which involves talking to sometimes intimidating doctors who can at times be rude.

Well, it was a steep learning curve in the first week of work, but you get used to it. Hopefully, my knowledge and confidence in procedures will increase over time, and I’ll be a great doctor later on. 🙂

Meta

I'm a male in his mid twenties working as a junior doctor. I'm passionate about medicine, and I love studying Chinese
I blog about medicine and life in general, because it's an outlet for me to express myself, and it helps me to put my thoughts into perspective.